title: Craniofacial morphology in pediatric patients with persistent obstructive sleep apnea with or without positive airway pressure therapy: a cross-sectional cephalometric comparison with controls.
abstract: BACKGROUND
  Compression on the midface with nasal mask-delivered positive airway pressure (PAP) therapy in growing patients might contribute to midface retrusion. The objective of this study was to investigate the association between long-term PAP use and craniofacial morphologic pattern in children with persistent obstructive sleep apnea.
  
  
  METHODS
  Images generated with cone-beam volumetric imaging were used to complete lateral cephalometric analyses of anteroposterior projection of the midface region. The study group included 12 subjects (10 boys, 2 girls; mean age, 9.0 years) who used PAP therapy for at least 6 months and at least 6 hours per night. Measurements from this group were compared with those of a control group of 11 subjects (5 boys, 6 girls; mean age, 9.6 years) with obstructive sleep apnea who did not have PAP. Measurements were taken at 1 time point.
  
  
  RESULTS
  No significant differences were identified between the groups for any cephalometric variable. Multivariate linear regression analysis also did not identify a significant association between the number of months of PAP therapy and the cephalometric variables. Cephalometric data for both groups were pooled for comparison with appropriate published normative values for age and sex. Anterior cranial base length, overall anteroposterior length of the maxillary base, and mandibular body length were significantly shorter than normal in the subjects compared with published normative values.
  
  
  CONCLUSIONS
  No association was demonstrated between midface projection and PAP use in growing patients. When compared with normative data for anterior cranial base, children with obstructive sleep apnea had shorter maxillary and mandibular lengths.
authors.affiliation: Clinical instructor, Division of Orthodontics, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
authors.forename: Mohammed M
authors.initials: MM
authors.lastname: Korayem
authors.forename: Manisha
authors.initials: M
authors.lastname: Witmans
authors.forename: Joanna
authors.initials: J
authors.lastname: MacLean
authors.forename: Giseon
authors.initials: G
authors.lastname: Heo
authors.forename: Hamdy
authors.initials: H
authors.lastname: El-Hakim
authors.forename: Carlos
authors.initials: C
authors.lastname: Flores-Mir
authors.forename: Paul W
authors.initials: PW
authors.lastname: Major
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002508:Cephalometry / Q000379:methods*; D002648:Child; D002680:Chin / Q000473:pathology; D054893:Cone-Beam Computed Tomography / Q000379:methods; D003430:Cross-Sectional Studies; D005147:Facial Bones / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D007180:Incisor / Q000473:pathology; D008297:Male; D008334:Mandible / Q000473:pathology; D008437:Maxilla / Q000473:pathology; D008445:Maxillofacial Development / Q000502:physiology; D009295:Nasal Bone / Q000473:pathology; D011175:Positive-Pressure Respiration; D012658:Sella Turcica / Q000473:pathology; D012886:Skull / Q000473:pathology*; D019291:Skull Base / Q000473:pathology; D020181:Sleep Apnea, Obstructive / Q000473:pathology* / Q000628:therapy